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12 DISTRICT PARISH STATE OF LOUISIANA DEPARTMENT OF TRASNPORTATION AND DEVELOPMENT BRIDGE INSPECTION REPORT ROUTE STRUCTURE NUMBER Form 3097_PO 09/2012 Page 1 of RECALL NUMBER CROSSING DESCRIPTION LENGTH BRIDGE TYPE YEAR BUILT POSTED LOAD CONDITION INSPECTION TOTAL RATING : DECK : CHANNEL : DATE : OVERALL RATING : SUPERSTRUCTURE : CULVERT : TYPE : TRAFFIC SERVICE : SUBSTRUCTURE : APPRAISAL WATERWAY ADEQ : BRIDGE RAILINGS : GUARDRAIL ENDS : APPROACH ALIGN : TRANSITIONS : PIER PROTECTION : SURFACE THICKNESS : APPR GUARDRAIL : SPECIAL DETAILS ACCESS EQUIPMENT (hrs) ATTACHMENTS PIN & HANGER : REACH-ALL : SKETCHES : Y / N 2-GIRDER SYSTEM : BUCKET TRUCK : PHOTOGRAPHS : Y / N 2-TRUSS SYSTEM : MARSH BUGGY : STREAMBED PROFILE : Y / N SUSPENSION SPANS : SCAFFOLDING : TIMBER RATING : Y / N X-GIRDER/FLR BEAMS : BOAT : 588 STEEL FORM : Y / N PIER CAPS : LADDER : MOVABLE BRIDGE INSP Y / N PERSONNEL RESOURCES INSPECTED BY : NO. OF INSPECTORS : APPROVED BY : MAN HOURS : DATE APPROVED : TEAM LEADER INITIALS : CONFIDENTIAL, PRIVILEGED, NON-DISCOVERABLE INFORMATION The information set forth in this document is privileged, confidential and exempt from disclosure under 23 U.S.C. 409 and other applicable law. if you recieved in error, you are on notice that unauthorized examination, disclosure, copying, distribution, or taking any action regarding this information is prohibited and you are requested to immediately seal and return this information unexamined and uncopied to the sender.
13 STR UNIT: STATE OF LOUISIANA DEPARTMENT OF TRANSPORTATION AND DEVELOPMENT BRIDGE INSPECTION REPORT ELEMENT CONDITIONS AND NOTES Form 3097_PO 09/2012 Page of TOTAL QTY UNITS TOTAL QTY UNITS TOTAL QTY UNITS TOTAL QTY UNITS TOTAL QTY UNITS
14 STR UNIT: STATE OF LOUISIANA DEPARTMENT OF TRANSPORTATION AND DEVELOPMENT BRIDGE INSPECTION REPORT ELEMENT CONDITIONS AND NOTES Form 3097_PO 09/2012 Page of
15 STR UNIT: STATE OF LOUISIANA DEPARTMENT OF TRANSPORTATION AND DEVELOPMENT BRIDGE INSPECTION REPORT ELEMENT CONDITIONS AND NOTES Form 3097_PO 09/2012 Page of
16 STR UNIT: STATE OF LOUISIANA DEPARTMENT OF TRANSPORTATION AND DEVELOPMENT BRIDGE INSPECTION REPORT ELEMENT CONDITIONS AND NOTES Form 3097_PO 09/2012 Page of
17 INSPECTION NOTES : STATE OF LOUISIANA DEPARTMENT OF TRANSPORTATION AND DEVELOPMENT BRIDGE INSPECTION REPORT Form 3097_PO 09/2012 Page of
18 STATE OF LOUISIANA DEPARTMENT OF TRANSPORTATION AND DEVELOPMENT QA/QC BRIDGE INSPECTION FIELD REVIEW REPORT FORM 3097_PO 09/2012 RECALL SPAN STURCTURE TYPE DATE OF INSPECTION TYPE FLOORING BRIDGE HAS TIMBER SPANS ONLY? T(RUE) OR F(ALSE) PAGE OF DECK THICKNESS (IN. AND THS.) DECK PLANK WIDTH (IN. AND THS.) WEARING COURSE (IN. AND THS.) RDWY WIDTH (FT. AND THS.) SPAN LENGTH (FT. AND THS.) CAP DEPTH (IN. AND THS.) CAP WIDTH (IN. AND THS.) STRINGER DEPTH (IN. AND THS.) STRINGER THICKNESS (IN AND THS.) DISANCE TO NEXT CENT-CENT (IN. AND THS.) 1 2 PILE SPACING (FT. AND THS.) PILE CIRC. (IN. AND THS) PILE SHELL PILE LENGTH THICKNESS (IN (IN. AND THS.) AND THS.)
19 STATE OF LOUISIANA DEPARTMENT OF TRANSPORTATION AND DEVELOPMENT BRIDGE INSPECTION REPORT Form 3097_PO 09/2012 Page of Streambed Profile Orientation to RDWY : Feature measured to: Top of Top of water: Bent No. Distance from beginning of structure Streambed Measurement Slope protection : Y / N Type : Channel Protection : Y / N Type :
20 DISTRICT STATE OF LOUISIANA DEPARTMENT OF TRANSPORTATION AND DEVELOPMENT UNDERWATER INSPECTION REPORT Form 3097_UW 03/2013 PARISH ROUTE STRUCTURE NUMBER RECALL NUMBER WATERWAY CROSSING INSPECTION DATE INSPECTION LEVEL INSPECTION LEVEL RECOM. INSP. FREQUENCY RECOM. SCOUR PROTECTION YES/NO MAX. WATER DEPTH NBI ITEM 60 SUBSTRUCTURE COND. TEAM LEADER NBI ITEM 62 CULVERT COND. DIVER NBI ITEM 61 CHANNEL COND. DOTD INSPECTOR STR UNIT: ELEM. DESCRIPTION TOTAL QTY UNITS STR UNIT: ELEM. DESCRIPTION PAGE 1 OF
21 STATE OF LOUISIANA DEPARTMENT OF TRANSPORTATION AND DEVELOPMENT UNDERWATER INSPECTION REPORT STR UNIT: ELEM. DESCRIPTION TOTAL QTY UNITS STR UNIT: ELEM. DESCRIPTION TOTAL QTY UNITS STR UNIT: ELEM. DESCRIPTION PAGE OF
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